Tag: obesity

Mediterranean diet helps offset the health impacts of obesity

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By Chrissy Sexton

The Mediterranean diet helps to counter the health impacts of obesity, according to a new study from Uppsala University in Sweden.

In 2015, four million deaths were attributed to excessive weight and more than two-thirds of those deaths were caused by cardiovascular disease (CVD).

“Despite the increasing prevalence of obesity, the rates of CVD-related death continue to decrease in Western societies, a trend not explained by medical treatment alone,” wrote the study authors. “These observations suggest that other factors might modify the higher risk of CVD associated with higher body mass. Potentially, one such factor is diet.”

The Mediterranean diet centers mainly around plant-based foods such as vegetables, fruits, herbs, nuts, beans, and whole grains. The diet also includes moderate amounts of dairy, poultry, eggs, and seafood, while red meat is only eaten occasionally.

A team led by Karl Michaëlsson set out to investigate how a Mediterranean-style diet among individuals with a higher body mass index (BMI) may affect all-cause mortality, with a particular focus on fatal cardiovascular events.

The study was focused on data from more than 79,000 Swedish adults enrolled in the Swedish Mammography Cohort and Cohort of Swedish Men.

Adherence to a Mediterranean-like diet (mMED) was assessed on a scale of 0 to 8, based on intake of fruits and vegetables, legumes, nuts, high-fiber grains, fish, red meat, and olive oil.

Over 21 years of follow-up, more than 30,000 participants died. The researchers found that individuals classified as overweight with high mMED had the lowest risk of all-cause mortality. Obese individuals who had high mMED did not have a higher mortality risk compared with those in the healthy weight group with the same diet.

By contrast, individuals with a healthy weight but low mMED had higher mortality rates compared to people in the same weight range who regularly adhered to a Mediterranean-style diet.

The findings were very similar among 12,000 participants who died from cardiovascular disease. The researchers determined that CVD mortality associated with high BMI was reduced by adherence to a Mediterranean diet, although it was not fully countered. Furthermore, lower BMI did not help offset the elevated CVD mortality risk associated with a low mMED.

“These results indicate that adherence to healthy diets such as a Mediterranean-like diet may be a more appropriate focus that avoidance of obesity for the prevention of overall mortality,” wrote the study authors. “Nonetheless, a healthy diet may not completely counter higher CVD mortality related with obesity.”

The research is published in the journal PLOS Medicine .

Mediterranean diet helps offset the health impacts of obesity

Higher BMI in early adulthood linked to increased dementia risk, new study suggests

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Risk is 1.8 times higher for overweight women and 2.5 times higher for men

by Ella Pickover

People who are overweight in early adult life may be more prone to dementia in later life, a study suggests.

Those aged 20 to 49 who have a high body mass index have a higher risk of dementia later on, the authors said.

Researchers from Columbia University in the US studied data on more than 5,000 adults.

Compared with women who had a normal BMI, those who were overweight had a 1.8 times higher risk of dementia later on in life.

Obese women had a 2.5 times higher risk.

For men, dementia risk was 2.5 times higher among those who were obese in early adulthood, according to the findings presented to the Alzheimer’s Association International Conference.

An association was found between being overweight or obese in mid-life – classed in the study as people aged 50 to 69 – among men but not women.

Both men and women have a higher chance of dementia if they are obese in later life, the researchers found.

Commenting on the study, Dr Rosa Sancho, head of research at Alzheimer’s Research UK, said: “This study links a higher BMI in early adulthood with an increased risk of dementia later in life and underlines the importance of maintaining a healthy weight to help support a healthy brain.”

But more studies are needed to examine the link in more detail, she said, adding: “We know that diseases that cause dementia get under way in the brain many years before symptoms start to show. Studies looking at our lifestyle in early adulthood are important to help us build a picture of the factors that could impact our brain health as we age.”

Fiona Carragher, director of research and influencing at Alzheimer’s Society, added: “A healthy and balanced lifestyle is an important step towards reducing the risk of dementia later in life.

“Previous research we’ve supported, such as the 2017 Lancet commission, has shown that obesity in mid-life may increase dementia risk, so it’s interesting to see a study that shows this may also be the case in younger people too. But this can’t tell us if high BMI is a direct cause of dementia, there could be other factors at play.

“The number of people living with dementia is set to rise to one million by 2025 so it’s becoming increasingly urgent that we find ways to prevent people developing the condition in the first place.

“We can all take steps towards a healthy lifestyle, whether it’s by watching our diets or making the most of the sunny days and getting outside for a walk – it’s never too late, or early, to make a change.

“Research funding also plays a vital role here, hit badly by the current pandemic – so it’s critical that the government commits to their pledge to double life-saving research funding for the chronically under-funded field of dementia.”

https://www.independent.co.uk/news/uk/home-news/bmi-early-adulthood-increased-dementia-risk-us-a9645101.html

Midlife Obesity in Women May Increase Risk for Dementia Later

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In women, midlife obesity is associated with increased risk for dementia later in life, while no clear associations are apparent for low body mass index (BMI), low caloric intake, or inactivity at baseline, according to a study published online Dec. 18 in Neurology.

Sarah Floud, Ph.D., from the University of Edinburgh in the United Kingdom, and colleagues recruited 1,136,846 U.K. women (mean age, 56 years) in 1996 to 2001 and asked them about height, weight, caloric intake, and inactivity. The women were followed until 2017 by electronic linkage to National Health Service records.

Fifteen years after the baseline survey, 89 percent of participants remained alive with no detected dementia, 18,695 of whom had dementia detected later (mean age, 77 years). The researchers observed an association between dementia detection during years 15+ and baseline obesity (BMI, 30+ versus 20 to 24 kg/m² rate ratio, 1.21); no clear associations were seen with low BMI, low caloric intake, or inactivity at baseline. These three factors correlated with increased dementia rates during the first decade; over time, these correlations weakened considerably, approaching null after 15 years.

“In this population, midlife obesity is the only factor examined that is likely to be causally related to dementia, perhaps chiefly through its effects on vascular disease,” the authors write.

https://www.physiciansbriefing.com/neurology-9/dementia-news-738/midlife-obesity-in-women-may-increase-risk-for-dementia-later-753066.html

These 6 Specific Exercises Can Cut Body Weight, Even if You’re Predisposed to Obesity

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by DAVID NIELD

We know that a range of factors influence weight, including those related to lifestyle and genetics, but researchers have now identified six specific exercises that seem to offer the best chance of keeping your weight down – even if your genes don’t want you to.

Based on an analysis of 18,424 Han Chinese adults in Taiwan, aged between 30 and 70 years old, the best ways of reducing body mass index (BMI) in individuals predisposed to obesity are: regular jogging, mountain climbing, walking, power walking, dancing (to an “international standard”), and lengthy yoga practices.

But interestingly, many popular exercise types weren’t shown to do much good for those who’s genetic risk score makes them more likely to be obese.

Specifically, exercises including cycling, stretching, swimming and legendary console game Dance Dance Revolution don’t appear to be able to counteract genetic bias (though are beneficial in many other ways).

“Our findings show that the genetic effects on obesity measures can be decreased to various extents by performing different kinds of exercise,” write the researchers in their paper published in PLOS Genetics.

“The benefits of regular physical exercise are more impactful in subjects who are more predisposed to obesity.”

Besides BMI, the team also looked at four other obesity measures for a more complete picture: body fat percentage (BFP), waist circumference (WC), hip circumference (HC), and waist-to-hip ratio (WHR).

Regular jogging – 30 minutes, three times a week – turned out to be the most effective way of counteracting obesity genes across all of them.

The researchers also suggest, based on the information dug up in the Taiwan BioBank database, that the less effective forms of exercise typically don’t use up as much energy, which is why they don’t work quite so well.

The researchers specifically noted that activities in cold water, such as swimming, could make people hungrier and cause them to eat more.

The study was able to succeed in one of its main aims, which was to show that having a genetic disposition towards obesity doesn’t mean that obesity is inevitable – the right type of exercise, carried out regularly, can fight back against that built-in genetic coding.

“Obesity is caused by genetics, lifestyle factors, and the interplay between them,” epidemiologist Wan-Yu Lin, from the National Taiwan University, told Newsweek. “While hereditary materials are inborn, lifestyle factors can be determined by oneself.”

It’s worth noting that not every type of exercise was popular enough within the sample population to be included: activities like weight training, table tennis, badminton or basketball may or may not be helpful, too. There wasn’t enough data to assess.

But with obesity numbers rising sharply across the world – and 13 percent of the global population now thought to quality as being obese – it’s clear that measures need to be taken to reverse the trend.

Being obese affects our physiological health in the way it increases the risk of cardiovascular disease, some cancers, and other issues; and there’s evidence that being seriously overweight can have a negative effect on our brains too.

Studies like this latest one can point towards ways of sticking at a healthy weight, even when the genetic cards are stacked against it. In some cases all it takes is a few minutes of exertion per day.

“Previous studies have found that performing regular physical exercise could blunt the genetic effects on BMI,” conclude the researchers.

“However, few studies have investigated BFP or measures of central obesity. These obesity measures are even more relevant to health than BMI.”

The research has been published in PLOS Genetics.

https://www.sciencealert.com/these-six-exercises-can-keep-weight-down-even-with-genetic-tendencies-for-obesity

Ohio high school senior loses 115 pounds by walking to school, changing diet

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By KATIE KINDELAN

Michael Watson, 18, battled his weight his entire life but decided to make a lasting change when he looked in a mirror his sophomore year of high school.

“When I looked in the mirror I was really ready to get it done and thought, ‘I can’t just fail anymore on my diet,’” Watson said. “I need to actually do this.”

Watson, now a high school senior in Canton, Ohio, started by walking to and from school every day, more than 40 minutes round trip.

He walked to school every day of his junior year, no matter whether it was hot, raining or snowing.

“When I took the bus to school, I’d want to sit by a kid and they’d say, ‘No, go sit somewhere else because I was so big,’” Watson recalled. “When I started walking, I didn’t even know what time the bus came and that was my motivation, ‘I have to walk.’”

Watson also changed his diet, working with his dad to learn how to count calories and then forgoing his normal fast food meals for salads, oatmeal and soup.

“It was extremely hard, especially at first,” said Watson, who also worked at a local Kentucky Fried Chicken restaurant during his weight loss. “What motivated me was stepping on the scale.”

“I’d see that I was 290 [pounds] and say, ‘Let’s get to 280, come on Michael, you got this,’” he said.

Watson started at his highest weight of 325 pounds. He now weighs 210 pounds, achieving a 115 pound weight loss.

In addition to walking, Watson now lifts weights in a home gym he created in his family’s garage.

“I lost a lot of my insecurities when I lost all that weight,” he said. “You work for it and you get it, so it feels amazing for sure.”

Watson’s father, Jim Watson, said he notices his son walk around now with “more confidence,” allowing him to show his “funny and outgoing” personality to more people.

Watson’s accomplishment caught the attention of his classmates and teachers at McKinley Senior High School, from which he will graduate later this month.

“His story stuck with me,” said Terrance Jones, a family support specialist at McKinley who nominated Watson for the school’s “Senior Limelight” recognition.

“Michael is a young man who aspired to be able to be a better person for himself. We’re not talking about athletic accomplishments or academic accomplishments, this is a personal development success,” he said. “We need to pay more attention to personal development successes with students.”

Watson plans to find a full-time job after graduation, possibly in the food industry. He studied in his school’s culinary program during his weight loss and credits his teacher in the program with helping him learn more about healthier food choices and cooking.

“I hope I can be an inspiration to others,” Watson said, adding that he achieved his weight loss by reminding himself that “every day is a new day.”

“That’s what I said on my diet all the time because I’d mess up some days,” he said. “I’d tell myself, ‘Tomorrow is a new day. You’ve’ got to start over and eat the oatmeal in the morning.”

https://abcnews.go.com/GMA/Wellness/high-school-senior-loses-115-pounds-walking-school/story?id=63047775

Hunger Hormone Ghrelin Induces Overindulgence

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Ghrelin, the hormone that makes you hungry, also makes food, and food smells, irresistibly appealing. Karen Hopkin reports.

By Karen Hopkin

‘Tis the season…for overeating! But it’s not just your lack of willpower or the omnipresent holiday treats. No, you can lay some of the blame on ghrelin. Because a new study shows that ghrelin, the hormone that makes you hungry, also makes food…and food smells…irresistibly appealing. The finding appears in the journal Cell Reports. [Jung Eun Han et al, Ghrelin Enhances Food Odor Conditioning in Healthy Humans: An fMRI Study]

Ghrelin is produced in the stomach, and its levels rise before your habitual mealtimes and after you haven’t eaten for an extended period. So the hormone reminds you to put something in your belly. Injecting rats with ghrelin encourages them to eat…and people who receive a dose of ghrelin grab extra helpings from the buffet.

But how does the hormone induce overindulgence? To find out, researchers at McGill University trained volunteers to associate random images with the smell of food. For example, every time they saw a tree, they might get a whiff of freshly baked bread. At the same time, some of the subjects received ghrelin; others got only saline.

The volunteers were then ushered into an fMRI machine, where the researchers watched their brains to see which parts got turned on by different images.

Seems that in subjects under the influence of ghrelin, the brain region involved in pleasure and reward lit up only when volunteers viewed the images they associated with food aromas. Their brain pleasure centers were disinterested in images that had not been paired with food smells.

Also, when participants were then asked to rate the pleasantness of the images, the ones who’d been exposed to ghrelin gave higher grades to the food-associated pictures than did folks who got no ghrelin.

https://www.scientificamerican.com/podcast/episode/hunger-hormone-ghrelin-aids-overindulgence/

Young children’s oral bacteria may predict obesity

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Weight gain trajectories in early childhood are related to the composition of oral bacteria of two-year-old children, suggesting that this understudied aspect of a child’s microbiota — the collection of microorganisms, including beneficial bacteria, residing in the mouth — could serve as an early indicator for childhood obesity. A study describing the results appears September 19 in the journal Scientific Reports.

“One in three children in the United States is overweight or obese,” said Kateryna Makova, Pentz Professor of Biology and senior author of the paper. “If we can find early indicators of obesity in young children, we can help parents and physicians take preventive measures.”

The study is part of a larger project with researchers and clinicians at the Penn State Milton S. Hershey Medical Center called INSIGHT, led by Ian Paul, professor of pediatrics at the Medical Center, and Leann Birch, professor of foods and nutrition at the University of Georgia. The INSIGHT trial includes nearly 300 children and tests whether a responsive parenting intervention during a child’s early life can prevent the development of obesity. It is also designed to identify biological and social risk factors for obesity.

“In this study, we show that a child’s oral microbiota at two years of age is related to their weight gain over their first two years after birth,” said Makova.

The human digestive tract is filled with a diverse array of microorganisms, including beneficial bacteria, that help ensure proper digestion and support the immune system. This “microbiota” shifts as a person’s diet changes and can vary greatly among individuals. Variation in gut microbiota has been linked to obesity in some adults and adolescents, but the potential relationship between oral microbiota and weight gain in children had not been explored prior to this study.

“The oral microbiota is usually studied in relation to periodontal disease, and periodontal disease has in some cases been linked to obesity,” said Sarah Craig, a postdoctoral scholar in biology at Penn State and first author of the paper. “Here, we explored any potential direct associations between the oral microbiota and child weight gain. Rather than simply noting whether a child was overweight at the age of two, we used growth curves from their first two years after birth, which provides a more complete picture of how the child is growing. This approach is highly innovative for a study of this kind, and gives greater statistical power to detect relationships.”

Among 226 children from central Pennsylvania, the oral microbiota of those with rapid infant weight gain — a strong risk factor for childhood obesity — was less diverse, meaning it contained fewer groups of bacteria. These children also had a higher ratio of Firmicutes to Bacteroidetes, two of the most common bacteria groups found in the human microbiota.

“A healthy person usually has a lot of different bacteria within their gut microbiota,” said Craig. “This high diversity helps protect against inflammation or harmful bacteria and is important for the stability of digestion in the face of changes to diet or environment. There’s also a certain balance of these two common bacteria groups, Firmicutes and Bacteroidetes, that tends to work best under normal healthy conditions, and disruptions to that balance could lead to dysregulation in digestion.”

Lower diversity and higher Firmicutes to Bacteroidetes (F:B) ratio in gut microbiota are sometimes observed as a characteristic of adults and adolescents with obesity. However, the researchers did not see a relationship of weight gain with either of these measures in gut microbiota of two-year-olds, suggesting that the gut microbiota may not be completely established at two years of age and may still be undergoing many changes.

“There are usually dramatic changes to an individual’s microbiota as they develop during early childhood,” said Makova. “Our results suggest that signatures of obesity may be established earlier in oral microbiota than in gut microbiota. If we can confirm this in other groups of children outside of Pennsylvania, we may be able to develop a test of oral microbiota that could be used in clinical care to identify children who are at risk for developing obesity. This is particularly exciting because oral samples are easier to obtain than those from the gut, which require fecal samples.”

Interestingly, weight gain in children was also related to diversity of their mother’s oral microbiota. This could reflect a genetic predisposition of the mother and child to having a similar microbiota, or the mother and child having a similar diet and environment.

“It could be a simple explanation like a shared diet or genetics, but it might also be related to obesity,” said Makova. “We don’t know for sure yet, but if there is an oral microbiome signature linked to the dynamics of weight gain in early childhood, there is a particular urgency to understand it. Now we are using additional techniques to look at specific species of bacteria–rather than larger taxonomic groups of bacteria–in both the mothers and children to see whether specific bacteria species influence weight gain and the risk of obesity.”

In addition to Makova, Craig, Paul, and Birch, the research team includes Jennifer Savage, Michele Marini, Jennifer Stokes, Anton Nekrutenko, Matthew Reimherr, and Francesca Chiaromonte from Penn State, Daniel Blankenberg from the Cleveland Clinic, and Alice Carla Luisa Parodi from Politecnico di Milano. INSIGHT (Intervention Nurses Start Infants Growing on Healthy Trajectories) is coordinated through the Penn State Milton S. Hershey Medical Center.

This work is supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); the Penn State Eberly College of Science; the Penn State Institute for Cyberscience; the National Center for Research Resources and the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH); and the Pennsylvania Department of Health using Tobacco CURE funds.

http://science.psu.edu/news-and-events/2018-news/Makova9-2018

The Brain’s Immune Cells are to Blame for Obesity-associated Cognitive Decline

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Obesity leads to cognitive impairment by activating microglial cells, which consume otherwise functional synapses in the hippocampus, according to a study of male mice published in JNeurosci. The research suggests that microglia may be a potential therapeutic target for one of the lesser known effects of this global health epidemic on the brain.

Nearly two billion adults worldwide are overweight, more than 600 million of whom are obese. In addition to increasing risk of conditions such as diabetes and heart disease, obesity is also a known risk factor for cognitive disorders including Alzheimer’s disease. The cellular mechanisms that contribute to cognitive decline in obesity, however, are not well understood.

Elise Cope and colleagues replicated previous research by demonstrating diet-induced obesity in mice impairs performance on cognitive tasks dependent on the hippocampus and results in loss of dendritic spines — the neuronal protrusions that receive signals from other cells — and activates microglia. Using genetic and pharmacological approaches to block microglial activity, the researchers established microglia are causally linked to obesity-induced dendritic spine loss and cognitive decline. The results suggest obesity may drive microglia into a synapse-eating frenzy that contributes to the cognitive deficits observed in this condition.

https://www.technologynetworks.com/neuroscience/news/brains-immune-cells-to-blame-for-obesity-associated-cognitive-decline-309339?utm_campaign=NEWSLETTER_TN_Neuroscience_2017&utm_source=hs_email&utm_medium=email&utm_content=65859986&_hsenc=p2ANqtz-8GahP4LE2EOoHR4ShLvP0WjIDGrQksSkIDt93_VTrGea3qFC8v7VaOr9RXxmjjl8VDuNn2DK1PVOXEa5FBOdgl-GvhlA&_hsmi=65859986

Surprising new way to treat obesity

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A UNSW-led team researching a drug to avoid insulin resistance was greeted with an unexpected result that could have implications for the nation’s rising rates of obesity and associated disease.

A novel drug is being touted as a major step forward in the battle against Australia’s escalating rates of obesity and associated metabolic diseases.

Two in three adults in Australia are overweight or obese. A long-term study between researchers at the Centenary Institute and UNSW Sydney has led to the creation of a drug which targets an enzyme linked to insulin resistance – a key contributor of metabolic diseases, such as type 2 diabetes.

The project has been a collaboration between the Centenary Institute’s Associate Professor Anthony Don, UNSW’s Metabolic research group and its leader Associate Professor Nigel Turner, and UNSW Professor Jonathan Morris’ synthetic chemistry group. Together, they set out to create a drug that targeted enzymes within the Ceramide Synthase family, which produce lipid molecules believed to promote insulin resistance in skeletal muscle, as well as liver and fat tissue.

The study has been published in the highly-regarded scientific journal Nature Communications. Surprisingly, although the drug was very effective at reducing the lipids of interest in skeletal muscle, it did not prevent mice (which had been fed a high-fat diet to induce metabolic disease) from developing insulin resistance. Instead, it prevented the mice from depositing and storing fat by increasing their ability to burn fat in skeletal muscle.

“We anticipated that targeting this enzyme would have insulin-sensitising, rather than anti-obesity, effects. However, since obesity is a strong risk factor for many different diseases including cardiovascular disease and cancer, any new therapy in this space could have widespread benefits,” says UNSW Associate Professor Nigel Turner.

While the study produced some unexpected results, it’s the first time scientists have been able to develop a drug that successfully targets a specific Ceramide Synthase enzyme in metabolic disease, making it a significant advancement in the understanding and prevention of a range of chronic health conditions.

“From here, I would like to develop drugs which target both the Ceramide Synthase 1 and 6 enzymes together, and see whether it produces a much stronger anti-obesity and insulin sensitising response. Although these drugs need more work before they are suitable for use in the clinic, our work so far has been a very important step in that direction,” says Centenary Institute’s Associate Professor Anthony Don.

https://newsroom.unsw.edu.au/news/health/surprise-result-researchers-targeting-high-rates-obesity

How brown fat keeps us warm

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Adipose Connective Tissue Stores Fat in Our Body. Credit: Berkshire Community College Bioscience Image Library

A new technique to study fat stores in the body could aid efforts to find treatments to tackle obesity.

The approach focuses on energy-burning tissues found deep inside the body – called brown fat – that help to keep us warm when temperatures drop.

Experts are aiming to find it this calorie-burning power can be harnessed to stop weight gain, but little is known about how the process works.

Previous studies have mainly relied on a medical imaging technique called PET/CT to watch brown fat in action deep inside the body. But the method is unable to directly measure the chemical factors in the tissue.

Scientists at the University of Edinburgh developed a technique called microdialysis to measure how brown fat generates heat in people.

The approach involves inserting a small tube into an area of brown fat in the body and flushing it with fluid to collect a snapshot of the tissues’ chemical make-up.

The team tested the technique in six healthy volunteers, using PET/CT to guide the tube to the right location.

They discovered that in cold conditions, brown fat uses its own energy stores and other substances to generate heat.

Brown fat was active under warm conditions too, when the body does not need to generate its own heat, an outcome that had not been seen before.

Researchers hope the technique will help them to analyse the specific chemicals involved, so that they can better understand how brown fat works.

Most of the fat in our body is white fat, which is found under the skin and surrounding internal organs. It stores excess energy when we consume more calories than we burn.

Brown fat is mainly found in babies and helps them to stay warm. Levels can decrease with age but adults can still have substantial amounts of it, mainly in the neck and upper back region. People who are lean tend to have more brown fat.

The study, published in Cell Metabolism, was funded by the Medical Research Council and Wellcome.

Lead researcher Dr Roland Stimson, of the British Heart Foundation Centre for Cardiovascular Science at the University of Edinburgh, said: “Understanding how brown fat is activated could reveal potential targets for therapies that boost its energy-burning power, which could help with weight loss.”

This article has been republished from materials provided by the University of Edinburgh. Note: material may have been edited for length and content. For further information, please contact the cited source.

Reference: Weir, G., Ramage, L. E., Akyol, M., Rhodes, J. K., Kyle, C. J., Fletcher, A. M., … Stimson, R. H. (2018). Substantial Metabolic Activity of Human Brown Adipose Tissue during Warm Conditions and Cold-Induced Lipolysis of Local Triglycerides. Cell Metabolism, 0(0). https://doi.org/10.1016/j.cmet.2018.04.020

https://www.technologynetworks.com/proteomics/news/how-brown-fat-keeps-us-warm-304351?utm_campaign=Newsletter_TN_BreakingScienceNews&utm_source=hs_email&utm_medium=email&utm_content=63228690&_hsenc=p2ANqtz-9oqDIw3te1NPoj51s94kxnA1ClK8Oiecfela6I4WiITEbm_-SWdmw6pjMTwm2YP24gqSzRaBvUK1kkb2kZEJKPcL5JtQ&_hsmi=63228690